Provider Demographics
NPI:1487014916
Name:SENIOR LIVING AT THE PINERY LLC
Entity Type:Organization
Organization Name:SENIOR LIVING AT THE PINERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYADEVI
Authorized Official - Middle Name:K
Authorized Official - Last Name:SEENICHAMY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, PHD
Authorized Official - Phone:303-808-4047
Mailing Address - Street 1:PO BOX 630696
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80163-0696
Mailing Address - Country:US
Mailing Address - Phone:303-808-4047
Mailing Address - Fax:303-617-1341
Practice Address - Street 1:6875 N WINDVIEW CIR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-6337
Practice Address - Country:US
Practice Address - Phone:303-808-4047
Practice Address - Fax:303-617-1341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23W266305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55575315OtherPROVIDER NUMBER